Are healing abutments being reused in periodontics residency programs in the United States? A survey-based study.

PURPOSE: Recent studies indicate that reusing healing abutments (HAs) may pose a risk of biomaterial cross contamination among patients. The intent is to investigate whether postgraduate periodontics residency programs in the United States are reusing dental implant HAs and determine if there is a standardization in the decontamination and sterilization protocol of used HAs. METHODS: An electronic survey consisting of-seven multiple choice and/or short answer questions pertaining to the re-use of HAs among postdoctoral periodontics programs was sent to program directors of 57 accredited dental schools in the United States via an online survey system (Qualtrics). Three follow-up remainder emails were sent to programs that did not respond after over a 6-month period. Data were analyzed using descriptive statistics. RESULTS: Of the 57 postdoctoral periodontics program directors contacted, only 14 responded with three programs (3/14, 21%) reported reusing HAs. Approximately, 46% stated their residents place dental implants in two stages, while ∼54% stated they used a one-stage protocol indicating varied time exposure of HA to the oral cavity. Even in a two-stage protocol, the extended time HA remained in situ varied from 4 weeks to 6 months. Each program reusing HAs employed a distinct decontamination approach highlighting a notable lack of standardization in practices. CONCLUSION: The findings from our study suggest that a minority of residency programs in the United States are reusing HAs. However, the limited number of responses leaves uncertainty regarding whether our findings underestimate the prevalence of this practice and accurately reflect the reality. Among those re-using HAs, there seems to be a lack of standardization in their decontamination, potentially leading to cross-contamination of residual biomaterial among patients.

Assessment of Detoxification Strategies for Used Dental Implant Healing Abutments: Macroscopic and Biological Implications.

PURPOSE: Dental implant manufacturers recommend healing abutments (HA) be used for single-patient use; however, reuse on multiple patients following decontamination and sterilization is common. This study aims to evaluate four decontamination strategies utilizing enzymatic agents, available in most clinical settings, to determine the level to which biomaterial can be removed in a group of previously used HA (uHA). Secondly, to determine the degree to which the decontaminated HA are capable of inducing an inflammatory response in-vitro compared to new, never used HA. MATERIALS AND METHODS: Fifty HA were collected following 2-4 weeks of intraoral use and distributed randomly into 5 test groups (Group A-E; n = 10/group). Group A: Enzymatic cleaner foam + Autoclave; Group B: Ultrasonic bath with enzymatic cleaner + Autoclave; Group C: Prophy jet + Enzymatic cleaner foam + Autoclave; Group D: Prophy jet + ultrasonic bath with enzymatic cleaner + Autoclave; Group E: Prophy jet + Autoclave. Ten new, sterile HA served as controls (Group "Control"). Residual protein concentration was determined by a Micro BCA protein assay while HA from each group were stained with Phloxine B and macroscopically examined for the presence of debris. To examine the inflammatory potential, human primary macrophages were exposed to HA and supernatant levels of 9 cytokines/chemokines profiles were analyzed using a multiplex bead assay. RESULTS: All test groups presented with differences in the degree of visual decontamination compared to Controls, with Groups D and E displaying the most effective surface debris removaland reduced protein concentration. Of the detoxification strategies, Groups D and E removed the greatest biomaterial while least effective was Group A. However, compared to Controls, multiplex assays revealed high levels of inflammatory cytokine secretion up to 5 days from all Test Groups (A-E) irrespective of the decontamination method used. CONCLUSION: Our study found that compared to new, never used HA, decontamination of uHA utilizing enzymatic cleaners failed to reestablish inert HA surfaces and prevent an inflammatory immune response in-vitro. Clinicians should not reuse HA even after attempts to decontaminate and sterilize HA surfaces.

Peri-implant disease education and diagnosis in the pre-doctoral curriculum.

PURPOSE: The purpose of this study was to assess how pre-doctoral periodontal programs in the United States of America are educating their dental students regarding the management of peri-implant diseases and secondarily, to determine if a current standard of teaching exists. METHODS AND MATERIALS: Electronic surveys were distributed to pre-doctoral program directors across 57 dental schools in the United States via a secure online survey system. The survey consisted of 19 questions pertaining to curriculum structure involving didactic and clinical management of peri-implant diseases. RESULTS: A total of 25 program directors (44%) responded, and data were analyzed using descriptive statistics. The results indicated a lack of standardization of pre-doctoral didactic and clinical curriculum among dental schools. CONCLUSIONS: Data pooled from 25 pre-doctoral periodontal programs in the United States show that there is currently no standardization in the dental school curriculum related to the didactic and clinical management of peri-implant diseases. The development of standardized content is recommended to assist program directors in assessing and enhancing educational experiences for dental students on the management of peri-implant diseases.

Used dental implant healing abutments elicit immune responses: A comparative analysis of detoxification strategies.

PURPOSE: To determine if healing abutments (HA) can be "decontaminated" using four strategies available in clinical settings and compare the detoxification efficacy by quantifying residual biomaterial and capacity to elicit an inflammatory response in-vitro. MATERIALS AND METHODS: Forty HA collected from subjects following intraoral use were randomly distributed into four test groups (A-D): A: autoclave only, B: ultrasonic bath plus autoclave, C: prophy-jet plus autoclave, and D: Scrub sponge plus autoclave. New, sterile HA: group E (Control). Residual protein concentration was determined by Micro BCA assay and stained with Phloxine B for macroscopic examination. HA were placed in human CD14+ monocyte derived-macrophage (mo-Mφ) cultures and supernatant collected at 4, 24, 48, and 5 days to analyze cytokine profiles using multiplex bead assay. RESULTS: Test groups showed visible differences in "decontamination" levels compared to control. Groups C and D showed most effective debris removal and lowest residual protein concentration. Multiplex assay showed marked induction of pro-inflammatory cytokines by groups A and B and to a significantly lower level by groups C and D. CONCLUSION: HA were not entirely "decontaminated" using common methods available relative to new, sterile HA and were capable of stimulating an immune response.